Tuberculosis Treatment

Treating TB typically requires taking antibiotics for several months.

Tuberculosis (TB) has affected humans for millennia, but no effective treatment for TB it existed until the mid-1800s, when the sanatorium cure was first conceived.

The sanatorium cure involved rest, fresh air, and a nutritious diet to strengthen the body's natural defenses against the bacteria that cause TB.

It also included isolation, to prevent others from becoming infected.

At the time, the disease was often referred to as "consumption" or "phthisis."

In some cases, doctors purposely collapsed all or part of a patient's lung, on the theory that this would allow the lung to rest. Opinions are divided as to whether it helped.

The first anti-tuberculosis antibiotic, streptomycin, was developed in the 1940s, and the incidence of the disease in the United States and in other developed countries plummeted soon thereafter.

However, tuberculosis is still common in poorer countries, and the number of cases in the United States began to rise again in the mid-1980s, largely as a consequence of the HIV epidemic and decreased funding for public health programs in general, and TB clinics in particular.

Tuberculosis Drugs

A number of drugs can be used to treat tuberculosis. The most commonly used are:

Because so many strains of tuberculosis have developed resistance to certain antibiotics, treatment is started with the administration of at least three — and preferably four — different antibiotics that have activity against TB.

Lab tests known as drug susceptibility tests can determine which antibiotics will be more likely to cure a given case of TB.

Drug treatment typically lasts for at least six months and sometimes longer.

Stopping treatment too early can result in a recurrence of the infection and can lead to the development of drug-resistant tuberculosis.

Isolation

Isolation is still a part of modern tuberculosis treatment.

A person with active pulmonary tuberculosis (as opposed to latent TB) should be isolated until he or she responds to treatment and has sputum TB tests that are negative (by so-called acid-fast smears) on at least two occasions.

This usually takes no more than two weeks.

Drug-Resistant Tuberculosis 'Superbugs'

The treatment of tuberculosis and control of the disease's spread has been complicated worldwide by the emergence of multidrug-resistant tuberculosis.

Sometimes referred to as MDR-TB, it's defined as strains of TB that do not respond to at least isoniazid and rifampin, the two drugs that are the cornerstone of TB treatment.

To some degree, infection-causing bacteria will adapt to become resistant to certain antibiotics, evolving into "superbugs" that are unaffected by most antibiotics.

But to a large degree, the way in which humans have used antibiotics over the years has sped up the process.

Overuse of antibiotics — for example, taking them to treat viral infections, for which they are ineffective — is one of the reasons certain bacteria have become resistant to common antibiotics.

Another is failing to take a full course of antibiotics when a bacterial infection is present.

When antibiotics are stopped early, the bacteria that have not yet been killed often develop resistance to the drug being used for treatment.

This is a common problem with TB treatment, where antibiotics need to be taken daily for several months.

Directly Observed Therapy

One of the approaches public health officials have taken to combat multidrug-resistant tuberculosis is directly observed therapy, or DOT.

In DOT, a trained healthcare worker provides each dose of medication, watches the patient swallow it, and documents that the medication has been taken.

Studies show a higher cure rate among patients receiving DOT than among those self-administering their tuberculosis drugs.

While anyone with tuberculosis is a candidate for DOT, the CDC specifically recommends that patients in the following groups receive it:

People with drug-resistant TB

People receiving intermittent therapy

Homeless or unstably housed people

People who abuse alcohol or illicit drugs

People who are unable to take pills on their own due to mental, emotional, or physical disabilities

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